Welcome to your daily briefing on healthcare developments in AB. Today we're covering 8 key stories including updates on alberta healthcare headlines, background & context. Let's dive in.
5 stories
Health data and statistics on various health topics — demographics, mortality, disease, and more in data table, dashboard or map formats.
Relevant to healthcare professionals operating in AB.
Gives people and patients information from their health records.
Relevant to healthcare professionals operating in AB.
As nursing homes continue to struggle with finding staff, the Centers for Medicare and Medicaid Services (CMS) is now requiring nursing homes, as of January 26, to report their employee turnover rates and weekend staffing levels for….
Relevant to healthcare professionals operating in AB.
Request administrative health data for various purposes, including research, planning and projects, and access online health data resources.
Relevant to healthcare professionals operating in AB.
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Relevant to healthcare professionals operating in AB.
Reach healthcare professionals
3 stories
Across most payors, the top-five denial reasons account for over 80% of prior-auth rejections: missing clinical documentation, wrong CPT/HCPCS code, service not in benefit plan, step-therapy not completed, and ordering provider not on the patient's plan. The same five repeat across plans because they are the easiest to deny on automation.
Practices that build a five-line pre-submission checklist around these reasons typically cut prior-auth denials by 40-60% within a quarter. The fix is process, not appeals capacity.
The MIPS cost performance category is calculated retrospectively by CMS using attributed Medicare claims; clinicians cannot directly affect what is attributed. The two attribution methods (TPCC and MSPB) capture different beneficiary cohorts. Practices that try to "manage" cost without understanding which patients are attributed to which clinician typically waste effort.
Cost is now 30% of the MIPS final score — the largest single category. Misunderstanding attribution is the leading cause of unfavorable payment adjustments in the next cycle.
Three application defects routinely delay payor enrollment: incomplete work-history explanations for any gap over 30 days, a malpractice carrier-history that does not reconcile with the explanation, and CAQH attestation that has lapsed. Each forces a back-and-forth with the credentialing committee.
A new clinician without active payor enrollment cannot bill for covered services for most plans. Each month of delay is foregone revenue that does not retroactively recover.
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